About this consultation
The College’s commitment to risk-based regulation requires a rigorous approach to policy development. This means revisions to the College’s policies and standards must be based on numerous factors including an evaluation of risks of harm, research evidence, and an analysis of options and impacts. This process ensures that our regulatory tools are not adopted as the default solution but are introduced to mitigate risk when other non-regulatory options are unable to deliver the desired results.
Consultation with midwives, midwifery and regulatory organizations, and the public is an essential part of our policy development process, and in keeping with our guiding principles of accountability and transparency.
The College’s Clinical Education and Student Supervision standard was implemented in 2014 and the current version was introduced in 2017. In 2021, the current version was revised by the Quality Assurance Committee (Committee) and went out for consultation in October 2021. Since that consultation, the Committee has made numerous changes to the standard. These changes are significant enough to warrant a second consultation.
This is the second round of consultations requesting feedback about the Clinical Education and Student Supervision standard.
The changes made to the Clinical Education and Student Supervision standard were designed to tie all standards to the public interest and to the delivery of client care. The changes also incorporated the feedback received during the first consultation about professional behaviours and providing a safe learning environment for students. These resulted in a revised standard that has been categorized into the following broad domains:
- clinical supervision and involvement in client care
- learning environment
- professional conduct and boundaries
New Title: the title of the standard was changed to Professional Responsibilities When Supervising Students to better reflect the standard’s intent to set out the requirements for midwives who are who are in a supervisory role during any aspect of midwifery care.
Definitions: The definitions of supervisor and conflict of interest were added and the definitions of direct supervision and indirect supervision were removed as these terms are no longer in the standard. The definition of student was simplified.
Details of what students are permitted to do: The details about what students are permitted to do, based on their clinical placement in the Midwifery Education Program, were replaced by minimum standards for midwives to ensure appropriate supervision based on the knowledge and skills of the student.
- Are the proposed requirements clear?
- Are risks of harm to the public addressed?
- Is the standard achievable for all midwives?
- Is there anything missing?
Midwife on May 10, 2022
My greatest concern is when a student midwife is made to feel demeaned by a preceptor, especially by a high ranking midwife, that a student may not want to stand up to or to challenge. All supervisors should be evaluated and reviewed by a non CMO panel, should concerns be expressed about punitive treatment, bullying, or unreasonable expectations. There should be lots of support and opportunity for students to honestly evaluate supervisors and preceptors, on a regular basis. Obviously from the comments, treatment of students being
bullied, is a big concern and must be end.
Midwife on May 10, 2022
I have no concerns with this standard as it is written. Should there be an element that outlines the supervising midwife must ensure that a client consents to a students involvement in their care? And that this consent should be revisited throughout the course of care.
Midwife on May 10, 2022
All good. Clearly defines the responsibilities
Midwife on May 10, 2022
Member of the public on May 10, 2022
Midwife on May 9, 2022
understand the new title but I have questions and commentaries
no distinction between supervisor and preceptor?
to me, supervision is linked with surveillance… is it what the CMO want to adopt as an attitude? This culture will have the risk of create also a culture of surveillance and conformity by midwives and have consequences on their practice with women.
is the CMO responsible to make sure that supervisor are assuming their role “adequately”?
how the institution responsible for the training of students will be able to set objectives of each clinical placement period?
Is the CMO now setting objectives of formation and the role of the supervisors?
how come that there is no more preceptor involve in the formation of students? I wonder how comes that now student midwives are ‘supervised” and not accompanied in their journey to become a midwife?
who will “certify” the supervisors and make sure that they assume their role appropriately? is there a mechanism to supervise them?
who nominate and supervise the supervisors?
what then is the role of the institution responsible for the adequate formation of student midwives? they are not autonomous with their program?
There’s a lot of “appropriate”. Seems to me a change in the culture of formation of midwives….. “appropriate”is vague…. appropriate for whom? compare to what?
Home on May 9, 2022
No comment.Its perfect
Member of the public on May 9, 2022
For the guideline #9 I think the wording “self-esteem” should be removed as it is personal entity rather than professional. Instead, there should be more clear guideline directly addressing negative behaviours such as racism or bullying.
Midwife on May 6, 2022
Overall the document is clear, and sets a reasonable standard for midwives who supervise students. Agree with previous comments that the word “professionalism” can be deleted from point 5. A simple change that increases equity without decreasing safety.
Point 7, regarding orientation, is unclear. “Proper orientation” is undefined. Maybe change to “sufficient orientation,” which better reflects the reality that orientation is an ongoing process that continues after the student has begun to provide direct client care.
Midwife on May 3, 2022
Overall the guideline is clear and concise. Like many others below, I think it could benefit from directly addressing providing a work environment “free from bullying, racism, sexism, ableism, and other forms of discrimination” … rather than just “safe and effective learning opportunities” – “safe” means different things to different people, so that could be better defined. Emotional & Physical safety are both important, as is cultural safety, etc.
Member of the public on May 2, 2022
PROFESSIONAL STANDARDS FOR CANADIAN MIDWIVES
A. Clinical Education and Student Supervision
I feel compelled to comment on the process of obtaining the information you require for the midwifery amendments and Policy development especially after reading through the materials you provided. The nature of the enquiry does not meet the conventional standards of a professional enquiry especially on Policy development. The following flaws were identified.
1. All professional inquiries should be scientific (unless you don’t consider midwifery to be scientific) in that there should be a recognizable scientific trail to the enquiry. I could not tell whether this is market research, a cross-sectional survey, or an attempt at qualitative enquiry. Perhaps I missed that because this is an ongoing exercise that started sometime back, and I did not participate then. In other words, there is no clear scientific methodology.
2. I noted that this seems to be like an open poll where anyone is invited to cast their vote. It does not specify who among midwives and the other categories mentioned should be involved. There is no inclusion/exclusion criteria for your enquiry. It is important to select among your chosen groups participants that understand policy formulation, development, and evaluation, and have experience in clinical knowledge acquisition and creation of a suitable, non-threatening learning environment. That way you get to work with quality data.
3. What numbers are you working with from your various categories? If you do not have a pre-determined figure, you run the danger of collecting massive data that is difficult to manage or little data that will not give you clarity on what you are looking for. That is problematic. It affects the quality of your inquiry and the results. Without clear categorization of participants, (data sources), analyzing this mix of data is difficult. What method of analysis will be applied? How do you ensure internal validity and reliability of the data collected?
4. The instrument for your inquiry is not clear. Is this a focus group discussion, a questionnaire or what? I am not familiar with an enquiry that requests participation from new participants while the enquiry is already under way. The flaws must be addressed.
B. Second Birth Attendant (non-midwife)??
The need for a second person is an admission of inadequate numbers of practicing midwives.
1.CMO should respond to this expressed need by training more midwives especially in a country where midwives are outnumbered by obstetricians, a situation that supports medicalization of a normal physiological process of childbirth in a woman. There is no reason why a low-risk woman should be cared for by an obstetrician. The numbers of midwives should surpass those of obstetricians. This reversed ratio of midwives to doctors suggests that many obstetricians in the country are practicing midwifery and not obstetrics while CMO fills its books with half-baked non-midwives to practice side by side with the midwife. This is yet another indication that there are inadequate numbers of midwives in the country. Why should the midwife be surrounded with lowly-trained unregulated people when conducting professional duties?
2.The fact that obstetricians who are trained for longer periods than midwives surpass midwives in numbers shows that obstetricians are more serious about developing their profession while CMO is satisfied with taking shortcuts by creating another non-professional cadre apart from the doula, around the professional midwife. It is like anyone who is not a midwife can practice side by side with the midwife. When a baby needs resuscitation a second midwife is more knowledgeable about risks than these cadres CMO is creating. A baby is precious. Most women who carry pregnancies to term want to hold live babies in their hands and not babies with cerebral complications due to poor management at birth.
3.Filling up midwifery professional gaps with aides makes the profession low-key and midwifery loses respect and professional standing among other professions. This is a retrogressive step that does not develop the profession. At this rate midwifery in this country will soon be rendered irrelevant and obstetricians will take on midwifery duties. The second person at delivery should be a midwife who can share skills and knowledge in case of emergency and when urgent professional and client management decisions are required.
4.Increase the numbers of midwifery student’s intake and open your doors to general nurses who want to practice midwifery to be able to do so. The focus in midwifery forums now is to increase numbers of midwives on the clinical area so that mothers are attended by a highly trained and knowledgeable midwifery professionals.
5.Midwifery is a noble profession and must not be diluted or destructed by training aides. Instead, there should be a focus on increasing and improving the knowledge base of the midwife.
Lastly, I am a Midwifery consultant and do not always participate in free for all open enquiries like this one. I charge a consultation fee for my work.
I hope you will pick something useful from my comments.
Midwife on April 29, 2022
Midwife on April 28, 2022
I agree with a previous comment that the term “professional” and also “professionalism” need to be defined. They can be problematic as they are often defined by people in a position of power and can be used to marginalize others.
I am supportive of removing specific roles at levels of learning. This is clearly defined within education programs.
Midwife on April 28, 2022
It seems clear. I would assume conflict resolution falls under the University umbrella?
Midwife on April 28, 2022
I find the new standard clear and concise. I note that others have commented negatively on the removal of the specific standards for students at each level; however, in my experience, when a student comes into their placement they are provided with a document detailing the skills they should aspire to attain. Therefore this level of detail is not needed in this stabdard. Further, this document is entitled “Professional responsibilities when supervising students”; thus it is aimed at the supervisor, not the student, so including the goals of the student at each level is unnecessary for the scope of this standard.
I agree with the comments regarding the need for language against the bullying or mistreatment of students. Students are vulnerable due to the inherent power dynamic at play between the student and the supervisor and even the most well meaning supervisor can appear to overstep the line. I am aware that the CMO and the AOM are making excellent efforts to offer education to this end, but a written statement in the standard would be beneficial.
Midwife on April 28, 2022
At a previous practice where I worked: the MPG was approached by Nurse Practitioner students that wanted clinical placements- as the university was based in the US, the liability insurance this student was holding likely would not have covered them in the case of a claim. Perhaps it is appropriate to direct midwives who are accepting these requests are aware of this concern.
Member of the public on April 28, 2022
Cmo is doing everything to clearly outlined regulations,good job
The Ottawa Birth and Wellness Centre on April 28, 2022
While I understand the spirit of this part of the standard, there is no language that reflects steps that will be taken if a student feels as though they have been a victim of bullying, harassment, discrimination, or otherwise. While these actions may not be directly impacting the public, they do impact students to such a high degree that the student may alter their actions/behaviours when engaging with the public in order to meet the “expectations” of the supervisor.
Midwife on April 28, 2022
Seems vague enough to allow autonomy
Midwife on April 26, 2022
I would appreciate if Professional Responsibilities When Supervising Students reflected anti-racism and anti-bullying values. I understand that many provincial associations and education programs have taken a stance of safer learning environments for students. However, I think it’s imperative that clear anti-racism and anti-bullying be adreesed from the College level in this document as well.
I echo many of the other comments, and also think more clearer guidelines of what students can and cannot do without direct supervision should be clearly outlined. Since all graduating students in Canada are regulated through the CMO I think it makes perfect sense for guidelines to come from the college and not from the education programs.
I’m surprised there is no mention about NR’s supervising learners.
Midwife on April 19, 2022
I think the proposed standard is generally clear and easy to understand. I do think a LOT of anxiety would be alleviated it if was clearer that the specific guidance about what students at various levels can and can not do is not disappearing, rather it (I’m assuming this to be the case) is being allocated where it belongs, within the protocols and policies of the learning institutions of the learners (ie. MEP/IMPP). So the specific guidance to supervisors will/should reside there, rather than with the CMO. I believe (presuming this is the case) that is actually appropriate.
There are two specific section where I see the potential for concern.
1)” Supervisors must continuously monitor and identify concerns about a student’s professionalism, performance or conduct that may affect client safety. Once identified, concerns affecting the safety of clients must be addressed immediately and effectively. ” “professionalism” is a poorly defined concept and can often be weaponized against IBPOC and other marginalized students. if the concern is that supervisors need to intervene when a student’s behaviour or performance of clinical skills places a client at risk, then limit this statement to that and leave “professionalism” out of the requirement. If you choose to leave “professionalism” in place, then it behooves you to be explicit about what you mean by the term and do so in a way that will not leave marginalized learners vulnerable.
2) “Supervisors must have the capacity and resources to deliver safe clinical supervision and practical experiences for a student. ” This statement doesn’t acknowledge that limitations in capacity and resources may occur at a systemic level that are beyond the scope of the individual supervisor to control or remediate. It’s reasonable to expect supervisors to only take on students within their practice groups if they have individual and practice level resources to do so. It’s not reasonable to expect supervisors to be able to influence hospitals, OHTs, the government or competing clinical educational programs that might have an impact on the students quality of experience in a way that might be unanticipated. ie. LU shutting down the MEP.
Midwife on April 14, 2022
I find the proposal to be very simple and streamlined. However, I have read some of comments and I don’t think that Under The Clinical supervision and involvement in client care part of the document About a student working independently is very clear as students under no circumstances will attend a birth by themselves. So perhaps it can be worded in a different way. Regardless as to what degree a student is at a registered midwife is and should always be present.
I think the guidelines are comprehensive. What I think is missing is a piece about accountability for preceptor/supervisor such as evaluations as to avoid mistreatment and abuse of students NR and midwives new to the profession.
Member of the public on April 13, 2022
As a current applicant for both MEPs in Ontario, the new standards are distressing. The clearly outlined responsibilities of a student, dependent on their placement level, was a helpful guideline for all parties involved. Removing these guidelines would murky the waters which could lead to patients feeling less confident about their care and students taking on more work than appropriate for their training. Removing these guidelines also puts the burden of responsibility on individual midwives when deciding what care is appropriate for a student’s skillset rather than the college. Therefore, I believe the guidelines should not be removed for everyone’s best interest.
Midwife on April 12, 2022
clear boundaries of what a student is allowed to.do when midwife off premises is/was a valuable tool that protects all involved from pressure for students to relieve overburden of midwife work
Midwife on April 11, 2022
Students are vulnerable and must be protected from bullying and racist behaviors. This statement is a no brainer but unfortunately not all midwives recognize these behaviors in themselves or in their colleagues. Some I suspect need education about what these behaviors include or how to be an antiracist, non authoritarian preceptor. It is beyond the scope of the standard to mandate members to look at their practice through a DEI lens but the CMO has a role to play in addressing problematic behaviors that start with member’s mistreatment of students and continue with their mistreatment of NRs, associate and junior partners leading to early burnout and disability amongst our newest members.
Ottawa Valley Midwives on April 11, 2022
In general I like the simplified new standard. I do think it is a mistake to take out the guidelines of what a student can do when a midwife isn’t directly on site (for postpartum visits or attending births). While of course a supervisor has to use her judgement as to when a student is safe to do these things, the former guidelines put out by the MEP are much relied upon. Without these I believe there is the possibility for the student and client to be put in unsafe situations because the practice is very busy and there is pressure for the student to work independently. Also, different supervisors will have different assessments of how independently a student is ready to work.
Member of the public on April 11, 2022
IT IS ESSENTIAL THAT STUDENTS ARE REGULATED TO ACQUIRE ADEQUATE KNOWLEDGE, SO AS TO BE COMPETENT IN DELIVERING QUALITY EVIDENT BASED CARE, ALONG WITH THE SECOND BIRTH ATTENDANT IN ACCORDANCE WITH STANDARD POLICIES,CULTURE AND PROCEDURES OF THE ORGANISATION.
Midwife on April 11, 2022
The footnote at the bottom that outlines the “typical” postpartum scheduling is too prescriptive and should not be included in this standard.